Decrease In Pain Level Research Articles

Efficacy and Toxicity of Hypofractionated Palliative Radiotherapy for Breast Cancer Patients with Skin Invasion

Objectives: To determine the efficacy and toxicity of palliative radiotherapy for locally advanced breast cancer patients with skin invasion.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Radiotherapy Department Combined Military Hospital, Rawalpindi Pakistan, Jan 2019 to Jun 2020.
 Methodology: Patients who received palliative radiotherapy for the breast cancer and received radiation of 24 Gray in 3 fractions to the breast/ chest wall were included. Radiation toxicity was assessed using RTOG criteria as the primary outcome of the study. Radiotherapy efficacy in controlling bleeding/discharge and improving pain and odour scores were the secondary outcomes.
 Results: Twelve (80%) patients reported improvement in pain, 13/18(72.2) patients reported improvement in bleeding and 24/25 (96%) patients a decrease in pain level (p-value < 0.001). 11/25(44%) developed Grade-2 skin toxicity, and 8/25 (32%) developed Grade-3 skin toxicity. No patient experienced Grade-4 skin toxicity.
 Conclusion: Our study has shown that hypofractionated radiotherapy is effective and safe for palliation of patients with locally advanced breast cancer and skin invasion.

Efficacy of corticosteroids on postoperative pain levels after nonsurgical endodontic treatment: An overview of systematic reviews

Introduction: According to previously published data, the severity of pain caused by pulp therapy and root canal treatment is more compared to other dental operative procedures. Corticosteroids are one of the most common drugs used in endodontics for reducing postoperative pain levels. The aim of this study is to compare and assess the effect of corticosteroids on postoperative pain levels with an active or passive placebo after nonsurgical endodontic treatment. Materials and Methods: The standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used for framing the review protocol and it was then registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022372527). In this overview, systematic reviews with or without meta-analysis that evaluated the efficacy of corticosteroids alone, irrespective of their route, time, dosage of administration, and tooth vitality, in controlling postoperative pain levels in teeth requiring root canal treatment were included. The assessment of multiple systematic reviews tool was used to investigate the methodological quality of the systematic reviews included in this review. Results: The majority of the studies that were selected for this review showed that using corticosteroids led to a significant decrease in pain levels following endodontic treatment, especially at 6 h after completion of treatment. Pain levels were reduced considerably when prednisolone was compared with other forms of corticosteroids. It is suggested that when prednisolone is administered 30 min before the commencement of root canal therapy, it is similar in its effect to using similar doses for a longer duration. However, further randomized controlled trials are required keeping the strict inclusion criteria in mind. Conclusions: The systematic reviews summarized in this overview support the conclusion that using corticosteroids greatly reduced postoperative pain following endodontic treatment, and they also dispel any misconceptions about corticosteroids’ routine use in moderation.

Benson's Relaxation Therapy to Reduce Postoperative Pain Intensity of TUR-P: A Case Study

Introduction: Benign Prostate Hyperplasia (BPH) is a disease condition in which there is enlargement of the prostate gland. This study aims to conduct a case study by analyzing nursing care by providing benson relaxation therapy on pain levels in TUR-P postoperative patientsMethods: Research design using case studies. The respondents used were 3 postoperative TUR-P people with acute pain nursing problems. The intervention provided was Benson's relaxation therapy. The instrument used is a pain assessment sheet. Data was analyzed using descriptive analysisResults: The results showed the main complaints of lower abdominal pain, pain like being stabbed, pain intensity disappeared arising and pain scale 6. The nursing diagnosis that emerged in 3 patients was acute pain with pain management intervention. The implementation of benson relaxation is carried out for 15 minutes Decrease in pain level 6 to 5 on the first day, 5 to 4 on the second day and 4 to 3 on the third day.Conclusion: Benson's relaxation therapy can reduce acute pain in patients with postoperative TUR-P.

Infiltration Between Popliteal Artery and Capsule of the Knee Combined with Adductor Canal Block as Analgesic Adjuvant During and Postoperative in Total Knee Replacement Surgery

Background: Infiltration between the popliteal artery and capsule of the knee (iPACK) is one method that has been proposed in recent years as a potential alternative to peripheral nerve block as analgesia in total knee replacement (TKR) procedures. This study presents anesthetic management using spinal anesthesia combined with iPACK and adductor canal block (ACB) in patients with grade IV osteoarthritis who underwent TKR of the right knee.
 Case presentation: A woman, a housewife aged 50 years, was planning to undergo TKR surgery. The patient came with complaints of pain in the right knee 1 year before entering the hospital. The patient was given supplemental oxygen with a nasal cannula at 3 liters per minute. Prior to spinal anesthesia, the patient was given fentanyl 25 mcg iv, ketamine 10 mg iv, and midazolam 1.5 mg IV as premedication. The patient was positioned on the right side, and a 27G Quincke needle was inserted at the level of L3-L4 and given bupivacaine heavy 0.5% 7.5 mg, then lateralized for 15 minutes. After lateralization, the patient was positioned supine and used ultrasound to direct ACB action with a regimen of ropivacaine 0.25% + dexamethasone 5 mg a volume of 20 ml, then iPACK was performed with a regimen of Ropivacaine 0.375% + dexamethasone 5 mg a volume of 20 ml. After surgery, the patient is treated in the recovery room for 1 hour until bromage score is 0. The patient received the PCA Morphine analgesic demand only 1 mg/mL, 1 mg per dose, max 5 mg over 4 hours, lockout interval 6 minutes; Paracetamol 500 mg every 6 hours PO; Ibuprofen 400 mg every 8 hours PO.
 Conclusion: TKR patients who were given analgesia using the ACB peripheral nerve block technique combined with iPACK experienced a decrease in pain levels and lower use of postoperative morphine so that patient mobilization was faster and reduced the patient's length of stay.

Educational intervention promotes injury prevention adherence in club collegiate men's lacrosse athletes.

Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries. Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices. Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury. Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001). The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.

The effectiveness and safety of blood flow restriction training for the post-operation treatment of distal radius fracture

Introduction Distal radius fracture (DRF) is a common injury in the upper extremities. Blood flow restriction (BFR) has been proven to be effective in improving function in low-load training, which is suitable for post-op rehabilitation. We explored the effectiveness and safety of BFR therapy in DRF patients who underwent surgery. Materials and methods Thirty-five patients were randomly assigned to either the BFR or the regular training (RT; no BFR therapy) groups. All patients completed the same 4-week postoperative rehabilitation program, including anti-inflammatory treatments, strengthening and range of motion (ROM) training. In the BFR group, the pressure was 120 mmHg in strengthening training course. Pain, circumferences of wrists and forearms, ROM, muscle strength, and D-dimer levels were evaluated at weeks 0, 2, and 4. Radius union scoring system (RUSS) was measured at weeks 4 and 12. Finally, wrist functionality (Cooney modification) was evaluated at week 12. Results The BFR group had significantly decreased pain levels compared with the RT group (p < 0.01, effect size= 2.33, −2.44 at weeks 2 and 4). Swelling was effectively relieved in both groups. The wrist swelling was less in the BFR group (p < 0.01, effect size = −2.17 at week 4). The isometric strength of wrist extension (p < 0.01, effect size = 1.5, 3.02 at weeks 2 and 4), flexion (p < 0.01, effect size = 1.33, 2.53 at weeks 2 and 4), and functionality significantly increased in the BFR group (p < 0.01, effect size = 2.80 at week 12). No risk of VT in the BFR group was found. BFR did not threaten bone healing. Conclusions In patients with DRF who underwent corrective surgery, BFR therapy effectively relieved pain and swelling, increased muscle strength and wrist function, and had no additional risks for bone healing and VT.

Elongating achilloplasty and the original tenorraphy technique for cerebral palsy

BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy.&#x0D; AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example.&#x0D; MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated.&#x0D; RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted.&#x0D; CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.

Effects of patient education on knee joint injections and the impact on patient care and satisfaction in rural Guatemala

Background: As the rates of osteoarthritis increase among the elderly population across the world, the number of intra-articular corticosteroid injections has also steadily increased. The objective of this research study was to compare the ratings of anxiety level, pain level, and education about glucocorticoid injections between the group who received expansive education about joint injections and the group who received minimal education about joint injections. Methods: Each participant was given a pre-injection survey allowing them to rate their anxiety level, pain level, prior education level on knee injections, and duration and severity of symptoms. Each participant completed a post-injection survey following the procedure. Rating data were analyzed using a paired t-test to compare each of the groups to themselves and unpaired t-tests were used to compare the two groups. Demographic and survey data were analyzed using Fisher’s exact test. Results: Statistical significance was noted when a paired t-test was run between pain levels before and after the knee injection was administered in group A and between pain levels before and after the knee injection was administered in group B (p&lt;0.001). A paired t-test also showed statistical significance when comparing the educational levels before and after the knee injection was administered in group A (p=0.04). Conclusions: This research study showed that increased education on corticosteroid knee injections prior to the procedure demonstrated increased education on corticosteroid knee injections after the injection and decreased pain levels following the injection in participants with osteoarthritis in rural Guatemala.

Slow Deep Breathing Therapy for Reducing Pain In Patients With Head Injury

Introduction: Head injury is one of the cases that can cause death for the sufferer. Complaints that patients with head injuries often feel are headaches. One of the non-pharmacological techniques that can be done is slow deep breathing or slow deep breathing relaxation, which physiologically can cause a relaxing effect. Objective: Knowing the description of head-injured patients with Slow Deep Breathing therapy intervention in reducing Pain. Methods: a descriptive case study with the subjects used were two patients through inclusion and exclusion criteria. Results: respondent H experienced a decrease in pain level from a pain scale of 6 (moderate Pain) to a pain scale of 3 (mild Pain), and Respondent F experienced a decrease in pain level from a pain scale of 4 (moderate Pain) to a pain scale of 2 (mild Pain). Conclusion: Slow, Deep Breathing Therapy can reduce Pain.

Anatomic Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears

Within the last decade, various highly diverse anterior cruciate ligament (ACL) preservation techniques have been proposed, as contemporary selective arthroscopic ACL preservation experienced a resurgence. Among surgical techniques, there are a variety of suturing, fixation, and augmentation methods, whereas a common thread, considering essential anatomic and biomechanical properties, is missing. This technique aims to anatomically reapproximate both the anteromedial (AM) and posterolateral (PL) bundles to their respective femoral footprints. Additionally, a PL compression stitch is performed to increase the ligament-bone contact area and recreate the anatomic vectors of the native bundles, therefore, creating a more anatomic and biomechanical construct. This technique is a minimally invasive procedure, with no graft harvesting nor tunnel drilling, which leads to decreased pain levels, earlier return of full range motion (ROM), and faster rehabilitation, while failure rates seem to be comparable to that of ACL reconstruction. We present an updated surgical technique of anatomic arthroscopic primary repair with suture anchor fixation for patients with proximal ACL tears.

Comparing the Impact of Early Versus Delayed Mobilization on Recovery Outcomes in Post-Surgical Patients: A Quantitative Analysis

Abstract Background: Early mobilization is increasingly advocated in postoperative care to enhance recovery outcomes. This study investigates the impact of early versus delayed mobilization on length of hospital stay, pain levels, functional capacity, incidence of complications, and patient satisfaction. Methods: A randomized controlled trial was conducted with 150 surgical patients divided into early and delayed mobilization groups. Data were collected on hospital stay duration, pain levels at 1 week and 1 month, functional capacity using the Functional Independence Measure (FIM), incidence of complications, and patient satisfaction scores. Results: The early mobilization group experienced a significantly shorter hospital stay (mean reduction of 2.5 days), lower pain levels at 1 week and 1 month, higher FIM scores at all follow-up points, and higher patient satisfaction scores. No significant differences were observed in the incidence of complications between the two groups. Conclusion: Early mobilization significantly improves postoperative recovery by reducing hospital stays, decreasing pain levels, enhancing functional capacity, and increasing patient satisfaction without increasing the risk of complications. These findings support the implementation of early mobilization protocols in surgical recovery plans.

Reconstruction of Peripheral Nerves after Neuroma, and Tumor Resection with Processed Allogenic Nerve Graft (AVANCE® Nerve Graft)

Introduction: Autologous nerve grafts are accompanied by morbidity of the donor site, leading to loss of sensation and possible complications such as end neuroma formation or persistent pain. Moreover, the indications are narrow mostly limited to defects in larger motor nerves with good prognosis. One alternative to autografts might be the commercially available allograft (Avance® Nerve Graft). The aim of this study was to assess the safety and outcome of the Avance® Nerve Graft for the reconstruction of peripheral nerves after neuromas, and tumor resection. Materials and Methods: For this purpose, ten patients with eleven implanted grafts were recruited for the prospective study. Five patients suffered from a neuroma-in-continuity, four from an terminal neuroma formation and two from Schwannomas. Seven patients were symptomatic for pain. After the resection, the peripheral nerves were reconstructed with the Avance® Nerve Graft. The patients were followed up for at least six months, by assessing recovery of motor, and sensibility and pain reduction. Results: A significant decrease in pain levels was observed after reconstruction. All patients achieved or remained a meaningful sensory function with levels of S3 or above. Regarding motor function, 85.7% (6 of 7 patients) demonstrated M3 or higher. One patient received a revisional reconstruction upon recurrent neuroma formation. In summary, all patients demonstrated signs of recovery and improvement of their paint situation. Nevertheless, one patient missed a meaningful motor recovery and a second one underwent an additional intervention. Conclusion: The reconstruction with Avance® Nerve Graft demonstrated good outcomes for motor, and sensory function, by achieving a pain reduction in all patients. Of particular interest, was the reconstruction of lesioned purely sensible nerves, for those currently no reasonable reconstruction option exists. Declaration of potential conflicts of interest The financial resources for the conduct of the RANGER study at the Medical University of Vienna are provided by Axogen Inc.

Artificial intelligence algorithms predict the efficacy of analgesic cocktails prescribed after orthopedic surgery.

Mixtures ('cocktails') of various analgesics are more effective in controlling post-operative pain because of potential synergetic effects. Few studies have investigated such effects in large combinations of analgesics and no studies have determined the probabilities of effectiveness. We used one-hot encoding of the categorical variables reported pain levels and the administered cocktails (from a total of eight analgesics) and then applied an unsupervised neural network and then the unsupervised DBSCAN algorithm to detect clusters of cocktails. We used Bayesian statistics to classify the effectiveness of these cocktails. Of the 61 different cocktails administered to 750 patients, we found that four combinations of three to four analgesics were by far the most effective. All these cocktails contained Metamizole and Paracetamol; three contained Hydromorphone and two contained Diclofenac and one Diclofenac-Orphenadrine. The ML probability that these cocktails decreased pain levels ranged from 0.965 to 0.981. Choice of a most effective cocktail involves choosing the optimum in a 4-dimensional parameter space: maximum probability of efficacy, confidence interval about maximum probability, fraction of patients with increase in pain levels, relative number of patients with successful pain level decrease. We observed that administering one analgesic or at most two is not effective. We found no statistical indicators that interactions between analgesics in the most effective cocktails decreased their effectiveness. Pairs of most effective cocktails differed by the addition of only one analgesic (Diclofenac-Orphenadrine for one pair and Hydromorphone for the other). We conclude that the listed cocktails are to be recommended.

Intramuscular Pressure and Patient-Reported Outcomes in Patients Surgically Treated for Anterior Chronic Exertional Compartment Syndrome.

Chronic exertional compartment syndrome (CECS) causes exercise-induced leg pain. The diagnosis is confirmed by intramuscular pressure (IMP) measurements. Fasciotomy has been demonstrated to be a successful treatment for CECS; however, few studies have examined postoperative IMP and long-term outcomes. To evaluate long-term outcomes and postoperative IMP in patients surgically treated for anterior CECS, and to identify possible preoperative or postoperative factors associated with overall satisfaction with treatment at follow-up. Case-control study; Level of evidence, 3. A consecutive series of 209 patients who underwent fasciotomy of the anterior compartment for CECS between 2009 and 2019 and had at least 1 year of follow-up were approached for inclusion. A total of 144 patients (69%), with a follow-up time of 1 to 11.5 years, were ultimately included. All patients underwent preoperative and postoperative 1-minute postexercise IMP measurements of the anterior compartment and completed a questionnaire covering pain and activity parameters at both time points. The follow-up questionnaire included an additional question on overall satisfaction with treatment, and surgical details were collected from the patient's medical records. The median IMP was significantly lower at follow-up than at baseline (17 mm Hg [range, 5-91 mm Hg] vs 49 mm Hg [range, 25-130 mm Hg]; P < .001). The overall satisfaction rate was 77%, and 83% reported a decreased pain level. The group of patients who were satisfied with the treatment included more men and had a higher ΔIMP and a lower revision rate (P < .05). Among the 16 patients (11%) who had undergone revision fasciotomies before follow-up, the satisfaction rate was 56%, and 64% reported a decrease in pain level. Fasciotomy significantly reduced 1-minute postexercise IMP in patients with CECS and resulted in satisfaction and decreased pain in more than three-quarters of the patients at long-term follow-up. The male sex and a significant decrease in IMP were both positively associated with treatment satisfaction. Patients who underwent revision surgery before the follow-up had lower satisfaction rates and less pain reduction than the overall group.

MODERN METHODS OF NON-INFLAMMATORY CHRONIC PELVIC PAIN SYNDROME TREATMENT

Relevance. Today there is an additional progressive option to apply into the non-inflammatory CPPS, which is presented by regenerative medicine and specifically platelet-rich plasma(PRP) treatment.&#x0D; Aim – to evaluate efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS.&#x0D; Materials and methods. Prospective study was conducted in a group of 40 outpatients with diagnosis of non-inflammatory chronic pelvic pain syndrome in Men’s Health Clinic (Kyiv, Ukraine). Mean age was equal to 46.4±10.2. The set of specific examinations included: trans-rectal prostate scanning, prostate secret sample analysis, visual analogue pain scale (VAS), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5).&#x0D; Results. Study results showed that there are significant differences in mean VAS scores in time point at 28-th day of treatment where patients of MG demonstrated lower pain level (p&lt;0.05) than patients of CG, meanwhile both groups had significant (p&lt;0.05) decrease of pain levels in comparison with initial data. In 3 months after treatment, we could see elevation of pain in CG to the level that have no significant differences with initial data, while patients of MG still have significantly lower pain level, but difference between groups come insignificant.&#x0D; IPSS levels at 28-th day of treatment showed significant (p&lt;0.05) efficacy (bringing symptoms from moderate to mild level) in both groups with lack of difference between them. Such situation was observer also in 3 months after treatment with slight increase of symptom intensity in both MG and CG. In 6 months after treatment, we have registered elevation of IPSS mean score in CG up to the level of insignificant difference with initial data.&#x0D; IIEF-5 data showed significant (p&lt;0.05) improvement of symptoms at 28-th day of treatment in both CG and MG without significant difference between groups. In 3 months after treatment, we observed that in CG the level of symptoms raised to the level that have insignificant difference with initial data, but in MG the improvement was still significant. The same situation was observed in 6 months after treatment.&#x0D; Conclusions. The efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS was evaluated. Significant clinical effects were found both for PRP combination with ESWT and NSAID and just ESWT and NSAID directly after course of treatment, meanwhile in 3 and 6 months after treatment the results start to show difference in favor of PRP inclusion.

Nursing Acute Pain in Patients With Bladder Cancer: A Case Study

Background: Severe pain in the lower right abdomen is often found in bladder cancer patients. Bladder cancer is a complex disease associated with high morbidity and mortality if not treated optimally. Patients who suffer from bladder problems say that the influence of medical personnel influences the most significant role in pain control. Nursing care for acute pain in patients with bladder cancer is still unknown. This study aims to describe nursing care for acute pain in bladder cancer patients. Methods: This research uses a case study design. Data collection from assessment to nursing evaluation was carried out in the Punai room of the Simpang Lima Gumul Hospital, Kediri Regency, in December 2021. The bladder patient was observed or treated for at least two days. Data collection techniques used were interviews, observation, and documentation. Data analysis was carried out using narrative analysis. Results: Mr. R, the main complaint felt by the patient is a pain in the lower right abdomen penetrating to the back. The nursing diagnosis in the case of Mr. R is the actual diagnosis of acute pain associated with physical injury (D.0077). Nursing intervention for Mr. R was compiled based on the diagnosis of acute pain using pharmacological techniques. Conclusion: The nursing problems Mr. R resolved after 48 hours of nursing intervention. The patient shows a decreased pain level with a pain scale of 2, and the patient plans KRS after 2 days the problem is resolved.

Lateral Epikondilitli Hastalarda Fizyoterapi Yaklaşımlarının Kısa Dönem Etkinliğinin Karşılaştırılması

The study aimed to investigate the short-term effects of radial nerve self-mobilization [RNSM], manual therapy [MT], and extracorporeal shock wave therapy [ESWT] on pain, pain-free grip strength, functional status, and patient satisfaction in patients with Lateral Epicondylitis [LE] and to determine the superiority of these methods to each other. 48 patients diagnosed with LE were included in the study and were randomly divided into three groups. RNSM was applied to all patients as a home program. The first group [n=16] received only the RNSM as a home program, the MT group [n=16] received MT combined with RNSM, and the ESWT group [n=16] received ESWT combined with RNSM. The RNSM was applied five days per week, and the MT and ESWT for two sessions per week for three weeks. Pain severity, pain-free handgrip strength, functionality levels, and patient satisfaction were evaluated before and after three weeks of treatment. The pain level significantly decreased, and handgrip strength and functionality increased in all groups after three weeks [p&amp;lt;0.001]. In comparison between the groups, the decrease in pain level, the increase in maximum grip strength, and patients' overall satisfaction scores were found to be higher in the MT group than in the ESWT, and only the RNSM groups [p&amp;lt;0.05]. MT application combined with radial nerve self-mobilization exercises in the treatment of LE appears to be more effective.

Cryotherapy in Knee Arthroplasty: Systematic Review and Meta-Analysis.

Total knee arthroplasty is performed to relieve knee pain and disability related to end-stage osteoarthritis. Cryotherapy is used as an analgesic method, reducing the intraarticular temperature. The objective of this study was to review the literature on the efficacy of cryotherapy in knee arthroplasty. A total of 700 articles were found in databases according to the search criteria for each database and the included descriptors (EndNote Web). After exclusion of duplicate articles, automatically and manually, Phase 1 was performed-reading of titles and abstracts of 375 articles according to the eligibility criteria by two blinded reviewers using the Rayyan QCRI (Qatar Computing Research Institute) program, conflicts were resolved in consensus between the 2 reviewers. Thus, 21 articles were selected for Phase 2-reading in full, leaving 5 articles for this review. The Cochrane instrument Rob 2 was used to assess the quality of bias of the selected studies, and RevMan 5.4.1 was used for meta-analysis. The age of study participants ranged from 51 to 74 years. The sample size ranged from 37 to 389 subjects, with a total of 648 subjects. The risk of bias was almost entirely high and moderate for all endpoints: pain, range of motion (ROM), and function. There was a decrease in pain level and as secondary endpoints ROM and functionality, there were divergences between studies. It can be concluded that although cryotherapy is indicated to reduce pain in the postoperative period of knee arthroplasty, studies have many methodological biases and the meta-analysis performed could not confirm the effects; therefore, more primary studies are needed to better understand the effects.

Percutaneous bone adhesive application for Jones fracture “at-risk” of nonunion or delayed union: a hypothesis

BackgroundBone adhesives have been on the forefront of orthopedic surgery research for decades due to the potential benefit they may have in fracture management. Current publications and research being conducted on bone adhesive could be applied to our current hypothesis for the benefit of a novel minimally invasive treatment option for a select cohort of fractures, Jones fractures. The select fracture’s gold standard of treatment would be nonoperative, but with risk of complications including nonunion and delayed union.Presentation of hypothesisWe hypothesize that percutaneous application of bone adhesive will provide an additional treatment option for fracture patterns that do not require operative fixation, but would benefit from additional stability. The primary outcome measures would be (1) duration of time required for bony consolidation (defined as 3 of 4 bridging cortices) and (2) duration of absenteeism (inability to work), and pain levels within the first week after the procedure. Secondary outcome measures would be the incidence of nonunion or delayed union. We hypothesize that the select bone adhesive would accelerate bony consolidation, decrease absenteeism, decrease pain levels within the first week after procedure, and decrease the incidence of delayed union and/or nonunion.Testing of hypothesisWe propose a prospective multicenter, randomized, and open label trial clinical trial to test the bone adhesive via percutaneous injection into acute non-displaced or minimally displaced Jones fractures.Implications of hypothesisBone adhesives are a new frontier in treatment of fractures, currently in laboratory and animal testing phases. The appropriate bone adhesive formula has not been approved for clinical trial use, but the implications of the bone adhesive may go beyond decreased complications and ease of stabilizing a select cohort of closed fractures. With the injectable compound illustrated (Fig. 1), the adhesive could be applied percutaneously in hopes of achieving improved outcomes compared to non-operative treatment. The overall goal of the clinical trial is to provide patients a safe treatment option for improved bone union rates of nonoperative fractures compared to the current gold standard management of the same fracture with earlier pain control, early bony consolidation and lower risk of delayed union/nonunion. The ideal patient population for use of a percutaneous bone adhesive in future studies would be for those with multiple medical comorbidities for whom surgical risks outweigh the benefits, in addition to patients at high risk for nonunion based on fracture pattern or systemic biology.

COMPREHENSIVE MIDWIFERY CARE TO MRS “S” G1P0A0 FEET SLUMP WITH HYDROTHERAPY AND PAIN AT ONE PERIOD OF LABOR WITH MASSAGE EFFLEURAGE AT “BI” CLINIC CIPATAT WEST BANDUNG DISTRICT

Introduction. Leg swelling is an inconvenience that often occurs in the third trimester of pregnancy and can be treated with hydrotherapy to reduce discomfort to the mother. Pain associated with childbirth is one of the most intense forms of pain that a woman in labor experiences. So it requires care to reduce pain and discomfort in the labor process, the method for pain reduction is by massage effleurage. Findings at BI” Clinic from 50 pregnant women as many as 37 pregnant women (75%) experienced leg swelling discomfort. This study aims to determine the effect of the intensity of leg swelling after hydrotherapy on leg swelling in the third trimester, effleurage massage in the first stage of labor. Methods. The study method sed is a case study by conducting an assessment to provide care. The study subject Mrs. "S" who experienced leg swelling in the third trimester of pregnancy and was given hydrotherapy intervention for 4 days was given routinely 2 times a day with a duration of 15 minutes, in the first stage of labor she was given 2 times effleurage massage care for 15 minutes in 30 minutes. Results &amp; Analysis. The results of the case study, namely Hydrotherapy, obtained an effect on reducing the level of swelling in the legs, in the first stage of labor, effleurage massage was given, after being given care there was an effect of decreasing pain levels, the mother felt comfortable and the intensity of pain was reduced. Discussion. The conclusion of the case study is that after hydrotherapy care, the swelling of the mother's legs decreases, then after being given effleurage massage in the first stage of labor the intensity of pain is reduced. It is recommended to remove “BI” clinic to further improve care, especially for pregnant women with swelling discomfort in the legs and care for mothers in labor with labor pains in the first stage.